Obstetric, Maternity & Gynaecology Services

Action Plan Arising from Royal College of Paediatrics and Child Health (RCPCH) Evaluation Progress Update as at 30 th September 2016 Obstetric, Maternity & Gynaecology Services Strategy & Patient Safety 1 Expedite the Phase Two business case and commence development to provide a high quality environment for consultant-led maternity care and compliant facilities for neonates. Formally establish Phase 2 project and develop business case for Welsh Government consideration. Outline business case by Summer 2016 Chief Executive (as SRO of Phase 2 Project Group) Phase 2 Project Group established November 2015. Scope of project confirmed and approved by BP&PAC. Phase 2 to include Neonatal Unit, Labour Ward and Obstetric Theatres / HDU facilities. Phase 3 to include Gynaecology, Antenatal, Postnatal and Children s service facilities. WG has committed 3m to support Business Case development for 2016/17. Outline Business Case submitted September 1

2016. Full Business case expected March 2016 2 Develop a clear sustainable strategy for obstetric, midwifery and gynaecology services, prioritising patient safety, patient access and quality of care, building on and completing the changes of services introduced in August 2014. New ideas, perhaps from a task and finish innovation group can refresh the team, harnessing external support to examine new ways of working with the support of the local clinicians and women Multi-disciplinary clinical group to be established involving consultant, midwifery and Gynaecology staff to develop strategy and prioritise innovation ideas and new practice. (Task & Finish groups to be agreed for specific projects). September 2016 General Manager, W&C Directorate Multi-disciplinary clinical group established. Reviews of Maternity Day Assessment and Ante Natal Clinic services in progress. Midwifery service model clear and reaffirmed. Consultant obstetric team currently considering options for future staffing model at WGH & GGH. Gynaecology service model to continue as at present pending further review post Phase 3 capital re-development. 3 Identify clinical line management for the Directorate to provide visible and robust professional support, mentoring and development to the clinical leads for obstetrics and paediatrics and the Head of Midwifery. An independent Acute Service operational structure to be reviewed. March 2016 Director of Operations Clinical leads for Obstetric & Gynaecology and Paediatric services in place. Professional support provided by Medical Director. 2

member at Board level should have a remit of responsibility for women's and children's issues Independent Board member with lead responsibility as Children s Champion to be confirmed In Place Mr Mike Ponton Independent Board member identified as Children s Champion 4 Expand community based consultant and midwifery based services at Withybush, developing more comprehensive EPU, EGU, day theatre, and clinical community based services there in line with RCOG standards 1 5 Retain provision of dedicated transport facilities 6 Rationalise major in patient gynaecological surgery onto one site, if accommodation allows. Plan for expansion of community based consultant and midwifery services to be developed by multi-disciplinary clinical group (referred to above). Renew SLA for DAV for 2016/17 Clinical Task & Finish Group to be established (involving Directorate & GGH / WGH site September 2016 March 2016 Review of capacity and service implications by June 2016 General Manager, W&C Directorate Executive Director of Commissioning Clinical Lead, O&G (via multi-disciplinary clinical group) Multi-disciplinary clinical group established. Reviews of Maternity Day Assessment and Ante Natal Clinic services in progress Health Board agreement to retain DAV for 2016/17). Multi-disciplinary clinical group established. Review complete. Gynaecology service model to continue as at 1 2013 Good Practice 15 Reconfiguration of women s services n the UK RCOG 3

representation) to undertake review of capacity and service implications present pending further review post Phase 3 capital re-development. 7 Phase out the obstetric and gynaecology out of hours consultant rota at Withybush with a target date of April 2016, integrating and strengthening the obstetric and gynaecological consultant team at Glangwili. Clinical Task & Finish Group to be established (involving Directorate & GGH / WGH site representation) to undertake review of capacity and service implications Review of capacity and service implications by June 2016 Clinical Lead, O&G (via multi-disciplinary clinical group) Multi-disciplinary clinical group established and review continuing. Consultant obstetric team currently considering options for future staffing model at WGH & GGH. 8 Review of the uptake of midwife led care, and plan for expansion of use by women who have been appropriately risk assessed. Unified patient pathways, guidelines and clinical governance structures must be incorporated into all units within 6 months Promote awareness of All Wales MLU guidelines amongst all midwifery staff. Monthly monitoring of MLU usage via Directorate. March 2016 February 2016 Senior Midwife MLU / Community Senior Midwife MLU / Community Continuous education programme in place. MLU utilisation routinely monitored via Directorate Q&S meeting. Establish March 2016 Senior Midwife MLU / 4

database of all women who are suitable for MLU care and audit of outcome Community Database established March 2016. Audits to be conducted on quarterly basis. Review all supporting pathways, guidelines and unit governance structures June 2016 Senior Midwife MLU / Community Review of pathways and guidelines complete. Single governance structure in place. 9 Assurance to public of the safety of birthing in MLU s in line with the All Wales Pathway for Maternity Care; community midwives should take a stronger lead in this. A band 7 midwife should be appointed to champion a team to develop each of the MLUs in terms of increased usage, active birth supporters and midwives competence and confidence in supporting active, non pharmacological birth. Develop communication strategy to engage with women across Hywel Dda to promote MLU as a viable option for giving birth Responsibility of Band 7 Community midwives to be confirmed. April 2016 March 2016 Senior Midwife MLU / Community Senior Midwife MLU / Community W&C Communication & Engagement Group established. Role and responsibilities of Community midwives confirmed. 5

Staff, Team & Leadership Development 10 Conduct medical staff job planning to provide a unified safe service which delivers professional satisfaction to staff across both sites. 11 Develop a programme of opportunities for midwifery development that reflects the aspirations of service developments these should be achieved within a 12 month period Review and update all job plans To be progressed in parallel with multi-disciplinary clinical group and midwifery OD programme. March 2016 General Manager W&C Directorate/Clinical Lead O&G December 2016 Head of Midwifery Interim Job plan reviews completed. To be further informed by outcome of recommendation 7. Multi-disciplinary clinical group established. Midwifery OD programme commenced December 2015. 12 In order to meet RCoA standards and secure future allocation of anaesthetic trainees further additional sessions are needed on the labour ward. Anaesthetic workforce development plan to be produced in parallel with HB IMTP. Workforce Development Plan by March 2016 (Implementation plan subject to IMTP) Service Delivery Manager, Anaesthetics Anaesthetic cover for Labour Ward and Obstetric theatres is prioritised. Capacity challenges within Anaesthetic service continue and further workforce priorities will be considered via 2017/18 IMTP development. 13 The multi-disciplinary training opportunities for doctors, nurses Multi-disciplinary clinical group to June 2016 Clinical lead O&G / Head of Midwifery 6

and midwives are considerable and need further development. A training lead should be identified to ensure training is carried out across all groups including simulation and skills/drills. review current multi-disciplinary training plan to ensure availability of appropriate skills. Multi-disciplinary clinical group established. Training programme in place. Obstetric and Midwifery training leads identified. Identify a training lead to coordinate training programme across multidisciplinary team. April 2016 Head of Midwifery Training lead confirmed. 14 A programme of organisational development should be instigated to build team working and a sense of one service ; across all staff groups from all three sites including community. This could be informed by the Fundamentals of Care audit, and include encouragement and time to nurture potential future medical leaders Implement programme of Organisational development for clinical staff, commencing with midwifery teams before consideration of roll out to medical staff and neonatal / paediatric teams. Commenced December 2015 Head of Midwifery OD programme in place with focus on culture, pathways/protocols and leadership/innovation. Initial review phase completed with feedback currently being provided to midwifery teams. Further work to be prioritised in light of feedback from initial phase. 7

Governance & Accountability 15 The new Band 7 maternity risk manager should administer the clinical governance programme including three monthly reports with action plans to the Trust Board and clinical directorate meetings Confirm appointment of interim Band 7 postholder within current resources March 2016 General Manager Interim Band 7 Risk Manager appointed. Substantive recruitment process underway. 16 The maternity dashboard, should be reviewed by the directorate Quality and Safety Committee quarterly for review and appropriate action. Review of compliance with the RCOG Maternity Standards should be under immediately and upon publication of the new standards expected during 2016 Ensure implementation of new All Wales Maternity Network Dashboard and include as standing agenda item at Directorate Q&S meeting. January 2016 Head of Midwifery All Wales Maternity Dashboard published and routinely monitored via Directorate Quality & Safety Meeting. Review compliance of new standards once published Once published O&G Clinical Lead/General Manager W&C directorate Unable to Commence Action Review to commence once standards are published. 8

17 Review of the midwifery workforce establishment using Birthrate Plus acuity tool should be completed immediately and at least every 2 years. Confirm HOMS recommended Birthrate Plus assessment tool March 2016 Head of Midwifery Preferred assessment tool confirmed. BR+ exercise to be conducted following confirmation of recommended tool. To commence upon confirmation of HOMS recommended assessment tool. Head of Midwifery BirthRate+ assessment currently underway. 18 Quality Improvement projects such as the Productive Ward, Releasing Time to Care should be used to involved all groups of staff in the quality improvement programme Quality improvement projects to be prioritised by multi-disciplinary clinical group. From February 2016. Head of Midwifery Multi-disciplinary clinical group established. Work programme developed. Multidisciplinary staff involved in current reviews of Maternity Day Assessment and Ante Natal Clinic services Public Engagement 19 The Maternity Service Liaison Committee should be re instated with membership drawn from local recent service users. Additionally the service should Programme of MSLC meetings to be reestablished. April 2016 Head of Midwifery Action Partially Completed 9 Planned re-establishment of MLSC postponed due to logistical difficulties in securing membership. Alternative approach

seek out ways to engage with the local families living in the three counties. currently in place with Midwifery managers meeting with service user groups (Postnatal, Breast-feeding, Learning Difficulties and SANDS/Bereavement groups). Women & Children s Communication & Engagement Strategy to be developed. April 2016 Head of Communications & Engagement W&C Communications & Engagement Group established. Communications strategy & plan approved by Phase 2 Project Group. Includes various mechanisms for engagement including drop in events, bespoke events for key groups including SANDs bereavement group, mother and toddler groups, sensory impairment and disability groups, virtual online engagement events with general public, Graffetti Boards used with current service users, poster briefings and feedback mechanisms. Feedback collected specifically on Phase Two but also for Phase Three and general responses. More broadly, service is collecting MLU user accounts of their experiences, and has setup a pilot closed Facebook group for Withybush MLU for expectant and new mothers to interact. 10

20 A social media campaign should promote positive birth experiences / normal birth in various media and establish a user group to provide feedback and advice on improving take-up of the MLU Women & Children s Communication & Engagement Strategy to be developed. May 2016 Head of Communications & Engagement W&C Communications & Engagement Group established and communications plan approved. Programme of media and social media case studies has started and will continue. We have set-up a pilot closed Facebook group for Withybush MLU for expectant and new mothers to interact. We are due to launch a new social media campaign using birth announcement infographics by end of Autumn 2016. 21 Ensure all staff in contact with expectant parents are fluent in the service arrangements, choices available for women, thresholds for transfer and outcomes. Refresher training /update on services to be provided to all midwives and Health Visitors March 2016 Head of Midwifery W&C Communications & Engagement Group established. Regular training programme in place. 22 Facilities for birth partners, whose partner may not be in established labour, to rest and obtain a hot drink should be available 24 /7 at Glangwili. Establish an interim facility pending Phase 2 redevelopment. March 2016 Senior Midwife Acute Interim facility pending Phase 2 now available adjacent to Dinefwr Ward. 11

Neonatal Service Strategic Planning & Patient Safety 23 Implement the Phase 2 developments to provide adequate accommodation for neonates and families. Formally establish Phase 2 project and develop business case for Welsh Government consideration. Outline business case by Summer 2016 Chief Executive (as SRO of Phase 2 Project Group) Phase 2 Project Group established November 2015. Scope of project confirmed and approved by BP&PAC. Phase 2 to include Neonatal Unit, Labour Ward and Obstetric Theatres / HDU facilities. Phase 3 to include Gynaecology, Antenatal, Postnatal and Children s service facilities. WG has committed 3m to support Business Case development for 2016/17. Outline Business Case submitted September 2016. Full Business case expected March 2016. 24 Gain commitment and support from the Health Board and The Wales Neonatal Network for a strategic plan for neonatal care towards designation of the unit as an LNU. Agree a joint development plan with the Wales Neonatal Network Agreement of plan by May 2016 Clinical Lead, Children s Services Joint development / action plan agreed with Neonatal Network. Phase 2 redevelopment will deliver LNU standard facility by end of 2018. Low probability of Health Board securing 12

dedicated tier of neonatal doctors as per LNU standard. to be reviewed in light of RCPCH update report following review revisit 29 th /30 th September 2016. 25 Conduct a training needs analysis amongst medical staff for competencies pertinent to operation as an LNU and a plan to meet those needs Training needs analysis to be under as per Wales Neonatal Standards. April 2016 Neonatal Clinical Lead Training Needs Analysis complete Outcome to inform joint development plan with Neonatal Network as above May 2016 Training programme in place. 26 With facilitated OD, continue to develop team cohesion and a sense of one service Extend Organisational Development programme to Neonatal Service clinical staff, following initial phase with midwifery teams. September 2016 Directorate Nurse Action Deferred 13 Action deferred due to capacity pressures within OD service to ongoing OD work within Midwifery service. In light of positive informal feedback received from RCPCH regarding improved culture within Neonatal service, recommendation to be reviewed in light of RCPCH update report

following review revisit 29 th /30 th September 2016. 27 Include EMRTS procedures into MLU protocols at WGH MLU protocol to be revised to reflect EMERTS availability. February 2016 Head of Midwifery MLU protocol approved by Directorate Q&S Committee. 28 Strengthen and formalise clinical meetings with Singleton, reviewing all cases weekly and documenting discussions and actions Programme of review meetings with Singleton NICU to be arranged. February 2016 Neonatal Clinical Lead Quarterly joint HDd / ABM Neonatal review meetings established. 29 Ensure the Wales Neonatal network guidelines are available to all staff working on the unit Ensure availability of Wales Neonatal Network Guidelines via shared drive on the Neonatal Unit. January 2016 Senior Nurse (Quality Assurance), Neonates Guidelines available via shared drive. 30 Review protocols and skills for emergency out of hours stabilisation given that CHANTS is not a 24-hour service. Review protocol(s) for emergency out of hours stabilisation January 2016 Neonatal Clinical Lead / Senior Nurse (Quality Assurance), Neonates Neonatal Network protocols for premature babies available on Unit. All supporting 14

31 Initiate and support opportunities for the neonatal leads to join sessions at the Singleton to help sustain and further develop their neonatal expertise. to support management of babies pending arrival of CHANTS retrieval service. Agree programme of joint rotations / visiting sessions with Singleton NICU team. April 2016 Neonatal Clinical Lead resuscitation guidelines are current. Action Partially Completed 1 Neonatal Consultant has visiting session at Singleton Hospital. ABM UHB Clinical Lead unable to support formal rotation at present time due to job plan pressures within ABM team. Issue to be revisited in 2017 following designation of Singleton Hospital as the 2 nd training NICU (Neonatal Intensive Care Unit) in Wales. 32 Ensure that all consultants providing out of hours cover have some daytime involvement on the neonatal unit which could be attendance at the weekly grand round as a minimum Remove all Community Paediatricians from acute on-call rota. December 2015 Clinical Lead Children s Services All consultants providing out of hours cover of Neonatal Unit have planned daytime sessions on Unit as part of Consultant of the Week rota. 33 Revisit the BLISS audit with service users and develop an action plan you said-we did Parent Support Group to be established to review audit and develop supporting action April 2016 Senior Nurse (Quality Assurance), Neonates BLISS Audit reviewed with accommodation / environment related issues considered by Phase 2 User Group to inform Unit design. 15

plan. Supporting staff and parental questionnaire responses currently being collated. Virtual Parent Support Group established via dedicated Facebook page for parents established as means of receiving direct feedback from parents. This is being used to consult with parents re logistics / feasibility of formal support group meetings. Access to Facebook page granted to BLISS. 34 Improve accommodation arrangements for parents and communicate them clearly, perhaps utilising the CHC to audit awareness Promote availability of current facilities / services for all parents pending improvement of facilities as part of Phase 2 redevelopment. Immediate Senior Nurse (Quality Assurance), Neonates Current overnight facilities redecorated. New supporting transport services (provided in partnership with 3 rd sector) implemented. Awareness of availability of current facilities for parents accommodation / transport services promoted by Unit Staff and included in Unit and handover meetings. Plans for CHC support to audit awareness being developed as part of Communications & Engagement Plan. Paediatrics & Emergency Care 16

Emergency Pathway 35 Clarify the governance, decision making and pathway arrangements for paediatric attenders out of hours, particularly the relationships between paediatrics, ED and the Out of Hours GP service so patients, public and referrers are clear about whom to refer to at different times of day and what telephone support is available from the Glangwili paediatricians to diagnose, treat and discharge locally where safe and appropriate. Review current policies and protocols From December 2015 Medical Director Policy review meeting led by Clinical Lead 18 th December 2015. Multi-stakeholder Acute Paediatrics Pathways Workshop chaired by Medical Director held 14 th March to further review pathways and inform future operational policies. Further Pathways Workshop to be arranged following confirmation of future paediatric consultant staffing model. 36 Continue with the relocation of the Withybush PACU nearer to the ED Progress PACU relocation in parallel with redevelopment of WGH. Spring / Summer 2016 General Manager / WGH Clinical Lead PACU Relocation plans being progressed via WGH CDU / Ward 10 Project. New PACU refurbishment works in progress. Re-location date to be confirmed. 37 Audit WAST out of hour paediatric decisions around 999 destination, with a group Undertake audit in conjunction with WAST and relevant clinical July 2016 Clinical Lead, Children s Services Out of hours activity and transfers reviewed routinely. Further review session to be 17

including anaesthetists, WAST, paediatric and ED staff and revisit criteria/refresh training as necessary 38 Provide a further 12 month extension to the DAV to March 2017 reviewing again once other changes have been made teams Renew SLA for DAV for 2016/17 March 2016 Executive Director of Commissioning arranged with WAST team due to incidence of WAST calls to WGH ED and PACU for advice. Board agreement to retain DAV for 2016/17 39 Ensure there are adequately qualified staff with paediatric resuscitation skills available at all times at WGH, perhaps through a programme of training and skills development for the anaesthetic team with rotation to other units to maintain skills. The paediatric team should play a leading role in overseeing arrangements 40 Strengthen nurse staffing in ED through urgent appointment of Registered Children s Nurses (one per shift) to provide general paediatric expertise. Longer term consider development of Emergency Nurse Practitioner Training / Skills development programme to be arranged ED workforce development plan to be produced in parallel with HB IMTP. From April 2016 Workforce Development Plan by March 2016 (Implementation Plan subject to IMTP) Clinical Lead WGH (with support from HB Resuscitation Training Team & Paediatric Team) Joint planning required between: Lead Nurse, WGH site Directorate Nurse, Children s Services Resuscitation skills training programme in place, supported by Resuscitation Team and Paediatric Team ED staffing recruitment / retention challenges continue to compromise attempts to ensure RSCN qualified staff per shift. Proposal re development of Paediatric Advanced Nurse Practitioner roles to be submitted for consideration via 2017/18 18

(ENP) roles, including nurse prescribers, and a 5-year plan for training and retention. Lead Nurse, Unscheduled Care IMTP. 41 Ensure that all staff who advise members of the public are aware of the correct clinical pathway to access early treatment and safe transfer. Review current policies and protocols and communicate to relevant staff. From December 2015 Clinical Lead, Children s Services. Policy review meeting led by Clinical Lead 18 th December 2015. Multi-stakeholder Acute Paediatrics Pathways Workshop chaired by Medical Director held 14 th March to further review pathways and inform future operational policies & model. Further Pathways Workshop to be arranged following confirmation of future paediatric consultant staffing model. Paediatric Care 42 Formally merge the paediatric consultant team and remove the out of hours cover for Withybush with a target date of April 2016 once the paediatric, nursing and management team are sure that appropriate emergency arrangements (training access Clinical Task & Finish Group to be established (involving Directorate & GGH / WGH site representation) to undertake review of capacity and Review of capacity and service implications by June 2016 Clinical Lead, Children s Services (via multi-disciplinary clinical group) PACU capacity and activity routinely monitored. Future options for provision of consultant support to WGH PACU from November 2016 to be considered by Executive Team October 2016. 19

transfer) are in place. This assurance should be supported by monitoring of all attendances out of PACU operating hours to ensure appropriate case management occurred, and identify any incidents resulting from the changes. service implications 43 Redesign job plans for consultants and speciality doctors to deliver Facing the Future standards including consultant cover at peak times Review and update all job plans March 2016 General Manager W&C Directorate/Clinical Lead, Children s Services In progress & Ongoing Job plan reviews continuing. To be further informed by outcome of 42. 44 Ensure there is sufficient outpatient capacity for all local children to be seen in clinics at Withybush. This would be for general paediatric problems and also subspecialty clinics. 45 Ensure that most investigations uncomplicated radiology and ultrasonography, venupuncture Review paediatric outpatient demand / capacity plans (to account for acute / community paediatric and subspecialty / visiting clinics) Review & Audit current availability of diagnostics March 2016 June 2016 Service Delivery Manager, Paediatrics Clinical Lead, Children s Services Action Partially Completed New middle grade rota introduced April 2016 to improve overall team capacity to support outpatient clinics at WGH. Significant recruitment challenges continue at consultant and middle grade level. Locum staff appointed to improve clinic capacity with additional provision of extra clinics by substantive staff. Investigations available at WGH. 20

and ECG can be under at Withybush and uptake at WGH for paediatric patients 46 Develop a vision for PACUs as a single service for the Health Board 47 Review, with primary care colleagues, compliance with the Facing the Future Together for Child Health standards and establish a plan for implementation and audit. Strategy for future development of PACUs to be developed (including review of operational policies for consistency) Establish task and finish group with primary care to review standards and plan for implementation. September 2016 October 2016 Clinical Lead, Children s Services / Directorate Nurse Children s Services Clinical Leads Children s Services / Primary Care Common operational principles underpinning all 3 PACUs. Local operational policies reflect variation in opening hours (WGH) Workshop with community teams scheduled for 7 th October 2016 to develop baseline assessment - for further consultation with wider primary care teams. 48 Continue development of the High Dependency service as part of the network with Cardiff as the local PICU, conforming to national standards 2 Review current PHDU service against national standards and identify areas for improvement. July 2016 Paediatric HDU Nursing Lead Review of PHDU service completed. Service conforms to local standards. Repeat audit against standards underway. 2 RCPCH/PICS Time to Move On 2015 21

49 Support investment in the Community Children s Health service towards compliance with the RCN 3 and RCPCH 4 guidance for community child nursing. There is an urgent need for recruitment of Consultant Community Paediatricians Develop a clear plan for community children s services Continue recruitment efforts to fill current vacancies. July 2016 From January 2016 Directorate Nurse Children s Services Clinical Lead, Children s Services Development plan for children s community service completed. Recruitment efforts continuing. Locum appointment commenced January 2016 and senior Associate Specialist appointed to locum consultant post. Additional sessions provided by substantive staff. 50 Develop the roles of specialist nurses, for example in epilepsy, asthma/ respiratory. Review current profile of specialist nurses and identify priority areas for development March 2016 Directorate Nurse Children s Services In progress & Ongoing Profile of specialist nurses reviewed and additional priorities identified. Posts not approved via IMTP and/or budget setting process 2016/17. Proposals to be re-considered via 2017/18 IMTP. 51 Review scope of on-call activity and maximise the role of nurses Review on call activity and demand May 2016 Clinical Lead, Children s Services On-call activities reviewed and job plans 3 NHS At Home developing Community Children s Nursing DH England 2011 4 Facing the Future Together for Child health RCOCH 2015 22

to help reduce pressure on doctors, including development of a criteria led nurse discharge programme. Identify opportunities for extended roles for nursing staff in support of medical teams and discharge pathways. June 2016 Directorate Nurse, Children s Services amended to reflect workload of on-call teams. Nurse-supported discharge arrangements in place with nursing teams working within clear clinical / discharge plans agreed with consultant paediatricians. Strengthen User Involvement & Public Engagement 52 Develop ongoing communications and engagement plan through the new committee to include Pushing positive birth stories to the media and staff Proactive analysis of the did we deliver materials Engagement of GPs with clear information about referral criteria Women & Children s Communication & Engagement Strategy to be developed. May 2016 Head of Communications & Engagement W&C Communications & Engagement Group established. Communications strategy & plan approved by Phase 2 Project Group. See also progress in 20. Multi-stakeholder Acute Paediatrics Pathways Workshop chaired by Medical Director held 14 th March to further review pathways and inform future operational policies & model, including primary care 23

53 Suggest CHC or user group be invited to audit/survey fathers about current arrangements and their experience of care. Women & Children s Communication & Engagement Strategy to be developed. May 2016 Head of Communications & Engagement W&C Communications & Engagement Group established. Communications strategy & plan approved by Phase 2 Project Group. CHC active member and contributed to establishment of a bespoke patient/user questionnaire for the Women and Children s Directorate, which is due to launch in Autumn (currently awaiting translation). This includes specific questions for partners. SMS patient feedback text service about to launch for maternity and paediatric services in October. 54 Re-establishment of the user group and MSLC Programme of MSLC meetings to be reestablished. April 2016 Head of Midwifery Periodic patient experience visits under by CHC. Action Partially Completed Planned re-establishment of MLSC postponed due to logistical difficulties in securing membership. Alternative approach currently in place with Midwifery managers meeting with service user groups (Postnatal, Breast-feeding, Learning Difficulties and SANDS/Bereavement groups). Women & Children s Communication & Engagement April 2016 Head of Communications & Engagement W&C Communications & Engagement Group established. Communications strategy & plan 24

Strategy to be developed. approved by Phase 2 Project Group. 25